Cryptogenic Stroke: The role of silent Atrial Fibrillation
|
|
- Sherilyn Olivia Lawrence
- 5 years ago
- Views:
Transcription
1 Cryptogenic Stroke: The role of silent Atrial Fibrillation PD Dr. med. Martin A. Ritter Westfälische Wilhelms-Universität Münster Germany 1 Turin,
2 Agenda 1. What is a cryptogenic? stroke Understanding the burden of cryptogenic stroke for individual patients and for society 2. Why bother with paroxysmal Atrial Fibrillation (AF)? 3. How to reliably detect (rare episodes of) paroxysmal AF? Strategies Can we predict paroxysmal AF? 4. What to do then? discussion 2 Turin,
3 Cardio-embolic stroke What is a cryptogenic stroke? Stroke classification according to TOAST Atrial fibrillation, criteria Ventricular aneurysm / thrombus etc. ~30% atherothrombosis Lacunar stroke Carotid stenosis / intracranial stenosis > 50% Aortic plaques, instable carotid plaque? ~15% Cerebral microangiopathy (Hypertension, Diabetes) ~15% Other defined etiologies Periprocedural, dissections, vasculitis, PFO, etc. ~10% Undetermined etiology Concurring etiologies, incomplete work-up cryptogenic strokes ~30% 3 Turin, Adams HP Jr, et. Al. Stroke. 1993;24:35-41.
4 What is a cryptogenic stroke? And understanding the burden of it A cryptogenic stroke is a stroke of unknown cause. The diagnosis demands a thorough and complete work-up of embolic or thrombotic sources 20-30% of all strokes have to be labeled as cryptogenic. That is about Germans or Italians each year! The diagnosis leaves doctors and patients unsure of the risk of future stroke and optimal secondary prevention big psychological problem! We suspect that a number of these patients does have AF we did not detect. 4 Turin,
5 Why bother with paroxysmal atrial fibrillation? Because risk of stroke does not differ greatly between paroxysmal or permanent AF! 1981 patients, Follow-up: 3.6 years Incidence rate of ischemic stroke: Cumulative 2,6% (paf) vs. 2,9% (caf) per year 5 Turin, Friberg L, et al. Eur Heart Journal 2009
6 How to track (rare episodes of) paroxysmal AF? Simple answer: Increase the time of monitoring! Do Holter ECG! Repeat Holter Do telemetry while in hospital! Do 3-7 day Holter Use external loop recorder (MCOT) Do continuous Monitoring (implantable cardiac monitors, ICM) 6 Turin,
7 Study overview: Detection rates of iaf with extended monitoring methods Definition of iaf varied widely In many studies episodes <30s of AF were accepted, and accounted for >50% of all pt.! 7 Turin, Khan M, Miller DJ. Detection of paroxysmal atrial fibrillation in stroke/tia patients. Stroke Res Treat. 2013;2013:
8 Increased monitoring times after stroke result in higher yields of silent AF! Stahrenberg R. Stroke. 2010; 41: Gladstone DJ. NEJM. 2014; 370;26: 2467 Only 69% of patients tolerated the device 5 days or more! Only 4 out of 5 patients had data for 21 days or more! 8 Turin,
9 Prolonged Monitoring = higher Yield Comparison studies in stroke patients Autor n Methodik / Dauer Yield Stahrenberg Stroke d Holter vs. 24h Holter 12,5 % vs. 4,8% Grond Stroke h Holter vs. 24h Holter 4,3% vs. 2,9% Rizios Stroke h stroke unit monitoring (dedicated analysis tool) vs. 24h Holter 7,6% vs. 2,8% Gladstone NEJM d externer loop recorder vs. 24h Holter 16,1% vs. 2,2% Ritter Stroke ICM (Reveal XT ) vs. 7d Holter 17,1% vs. 1,6% 9 Turin,
10 Continuous monitoring has the highest diagnostic yield Implantable cardiac monitors (ICMs) should have the highest yield 10 Turin, Botto G, et al. J Cardiovasc Electrophysiol 2009; 20:
11 ICMs are implanted subcutaneously under local anesthesia e.g.: Reveal XT algorithm detects episodes >2 min. (programmable) XPECT study, : sensitivity (96,1%) and specificity (85,4%) vs. Cardiologist evaluated Holter monitoring in pt. c. known iaf Hindricks G, et al.. Circ Arrhythm Electrophysiol Turin,
12 Pilotstudies using ICMs in cryptogenic stroke patients Autor n Duration of monitoring Median until first episode of iaf Additional Yield Ritter Stroke Median 397 d 64 d 17.1% Cotter Neurology Median 229 d (withoutaf) 48 d 25.5% Etgen Stroke year 153 d 27.3% Christensen Eur J Neurol Mean 569 d Mean 109 (±48) d 16.1% 12 Turin,
13 CRYSTAL-AF, n= Turin, Sanna T., et al: N Engl J Med 2014;370:
14 CRYSTAL AF: Baseline Characteristics: ICM Control Age 61.6 ± 11.4 years 61.4 ± 11.3 years Gender - Male 142 (64.3%) 138 (62.7%) Index Event Stroke 200 (90.5%) 201 (91.4%) Index Event TIA 21 (9.5%) 19 (8.6%) Pre-enrollment AF screening Holter Monitoring Pre-enrollment AF screening Telemetry Time between index event and randomization Time to randomization and device insertion 71.5% of patients Median of 23 hours (IQR 21-24) 29.9% of patients Median of 48 hours (IQR 36-96) 70.9% of patients Median of 24 hours (IQR 22-24) 29.5% of patients Median of 72 hours (IQR 48-96) 36.6 ±28.2 days 39.6 ±26.9 days 8.7 ± 27.6 days n/a 14 Turin,
15 CRYSTAL AF, Secondary Endpoint: Detection of AF at 12 months 12,4% 2,0% 15 Turin, Sanna T., et al: N Engl J Med 2014;370:
16 Can we predict iaf? Can we select the ideal patient for prolonged monitoring? - Clinical predictors: - age - CHADS 2 andcha 2 DS 2 -Vasc Score - Echoparameters: - E.g. atrial size - ECG parameters - e.g. SPBs 16 Turin,
17 Predict iaf by clinical scores? no significant clinical predictors in our study noaf (n=50) iaf (n=10) age 61; ; n.s. Female % (n) 40 (20) 60 (6) n.s. Hypertension % (n) 70 (35) 70 (7) n.s. Diabetes % (n) 14 (7) 0 p=0.1 CHF % (n) 0 0 n.s. Vascular disease % (n) 8 (4) 0 n.s. CHADS 2 -Score 3; 2-3 3; n.s. CHA 2 DS 2 -VASC Score 4; 3-5 4; 3-5 n.s. Insular cortex involvement 14 (7) 10 (1) n.s. Total monitoring time[d] Time to implantation after event [d] 397; ; ; ; n.s. n.s. 17 Turin, Ritter MA et al.; Stroke 2013
18 Cotter et al.: Classical risk factors predict iaf Cotter PE, et al. Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke. Neurology Apr 23;80(17): Turin,
19 Prediction of iaf according to purely clinical risk scores is ineffiecient! 1368 patients screened 416 had AF within 1,1 y. No differences in CHADS 2 - score However: Different population (TRENDS study, known cardiac disease) Different devices (ICD, PM, CRT) 19 Turin, Ziegler PD et al. Am J Cardiol. 2012:110:
20 Subgroup Analysis of CRYSTAL AF: Trend for higher yield of iaf in higher CHADS2 scores 20 Turin,
21 Cotter et al.: Classical risk factors predict iaf - and also echo and ECG parameters! Cotter PE, et al. Incidence of atrial fibrillation detected by implantable loop recorders in unexplained stroke. Neurology Apr 23;80(17): Turin,
22 22 Turin,
23 Thoughts on consequences for future patient selection for ICMs - 1 ILRs are much more sensitive than 7 day Holter! Most patients detected within 3 mo. from implantation, but there is significant yield beyond this! 7 or 30 days of monitoring are not enough! Emergent questions: How long should a monitoring be performed (in order to attribute a positive result to the recent event)? Is anticoagulation really the answer for all patients with iaf ( AF burden ) How about PFO and iaf? 23 Turin,
24 Thoughts on consequences for future patient selection for ICMs 2 Who is a candidate for extensive monitoring = ICM? Complete work-up performed and stroke is cryptogenic Patients with numerous SBPs and SVRs on 24h Holter You think it s AF (stroke pattern plus risk factors but you can not prove it yet!) Relatively fit patients Compliance with telemetry a lot to lose 24 Turin,
25 Summary % of patients with cryptogenic stroke do have iaf 2. Detection requires at least 3-12 months extensive monitoring 3. It is not possible to predict the occurrence of AF according to clinical risk factors the final word on paraclinical parameters (echo, 24h Holter) has not been spoken 4. Up to now any diagnosis of AF according to cardiological guidelines is currently relevant and should be followed by anticoagulaton 25 Turin,
26 Thank you for your attention! 26 Turin,
ECG monitoring after ischemic stroke of TIA of unknown source with an insertable monitor? YES
ECG monitoring after ischemic stroke of TIA of unknown source with an insertable monitor? YES Isabelle C Van Gelder University Medical Center Groningen The Netherlands ESC stroke council Prague January
More informationWhat the general cardiologist should know about arrhythmia Stroke prevention in AF" Peter Ammann Kantonsspital St. Gallen
What the general cardiologist should know about arrhythmia Stroke prevention in AF" Peter Ammann Kantonsspital St. Gallen What the cardiologist should know about arrhythmia and stroke are there real low
More informationTrue cryptogenic stroke
True cryptogenic stroke Arne Lindgren, MD, PhD Dept of Clinical Sciences Lund, Neurology, Lund University Dept of Neurology and Rehabilitation Medicine Skåne University Hospital Lund, Sweden Disclosures
More informationImplantable Cardiac Monitors for Atrial Fibrillation (AF) Detection: Ready for Routine Use?
Implantable Cardiac Monitors for Atrial Fibrillation (AF) Detection: Ready for Routine Use? Helmut Pürerfellner, MD, Assoc. Prof. Saint Elisabeth s Sisters Hospital Academic Teaching Center Linz/Austria
More informationTOP 3: EMBRACE. Lucy Vieira MD FRCP Neurologist MUHC. N Engl J Med Volume 370(26): June 26, David J.
TOP 3: EMBRACE N Engl J Med Volume 370(26):2467-2477 June 26, 2014 David J. Gladstone et al Lucy Vieira MD FRCP Neurologist MUHC Receiving research funds AstraZeneca 2014-2016 Original Article Atrial Fibrillation
More informationDiagnosing atrial fibrillation using implantable devices
Diagnosing atrial fibrillation using implantable devices Axel Brandes, MD, FESC Associate Professor of Electrophysiology and Cardiac Arrhythmias Dept. of Cardiology, Odense University Hospital, DK HRC
More informationAtrial fibrillation: why it's important to make opportunities diagnosis in single chamber ICD patients
ADVANCES IN CARDIAC ARRHYTHMIAS and GREAT INNOVATIONS IN CARDIOLOGY Turin October 13-15, 2016 Atrial fibrillation: why it's important to make opportunities diagnosis in single chamber ICD patients Dott.
More informationSpeakers. 2015, American Heart Association 1
Speakers Lee Schwamm, MD, FAHA Executive Vice Chairman of Neurology, Massachusetts General Hospital Director, Stroke Service and Medical Director, MGH TeleHealth, Massachusetts General Hospital Director,
More informationCryptogenic Stroke: What Don t We Know. Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare
Cryptogenic Stroke: What Don t We Know Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare Financial Disclosures None Objectives Principles of diagnostic evaluation
More informationDefining Sub-Clinical Atrial Fibrillation and its management
Defining Sub-Clinical Atrial Fibrillation and its management Jeff Healey MD, MSc, FRCP, FHRS PHRI Chair in Cardiology Research Population Health Research Institute McMaster University, Canada Sub-Clinical
More informationUTILITY OF THE IMPLANTABLE LOOP RECORDER
UTILITY OF THE IMPLANTABLE LOOP RECORDER John Andriulli, DO Associate Professor of Medicine Director, Arrhythmia Device Program Cooper Medical School of Rowan University Contemporary Practices in Cardiology
More informationDevice detected AF and atrial high rate episodes
Device detected AF and atrial high rate episodes Professor Paulus Kirchhof University of Birmingham Institute of Cardiovascular Sciences SWBH and UHB NHS trusts, Birmingham, UK Department of Cardiovascular
More informationΘα πρέπει να αναζηηείηαι η παροσζία ζιωπηλής κολπικής μαρμαρσγή ζε αζθενείς με κρσπηογενές εγκεθαλικό επειζόδιο; Ποιά είναι η καλύηερη μέθοδος;
Θα πρέπει να αναζηηείηαι η παροσζία ζιωπηλής κολπικής μαρμαρσγή ζε αζθενείς με κρσπηογενές εγκεθαλικό επειζόδιο; Ποιά είναι η καλύηερη μέθοδος; Νικόλαος Φραγκάκης Λέκηορας Καρδιολογίας, FESC Ιπποκράηειο
More informationCausal relationship between AF & stroke
7 AP-HRS Scientific Session, New Dehli, India - Oct 29 to Nov 1, 2014 Causal relationship between AF & stroke Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation - Venice,
More informationThromboembolism During Sinus Rhythm in Patients with a History of Atrial Fibrillation
48 th Annual New York Cardiovascular Symposium Thromboembolism During Sinus Rhythm in Patients with a History of Atrial Fibrillation Is Left Atrial Appendage Dysfunction Sufficient to Generate Clots? December
More informationCryptogenic Strokes: Evaluation and Management
Cryptogenic Strokes: Evaluation and Management 77 yo man with hypertension and hyperlipidemia developed onset of left hemiparesis and right gaze preference, last seen normal at 10:00 AM Brought to ZSFG
More informationCausal relationship between AF & stroke
7 AP-HRS Scientific Session, New Dehli, India - Oct 29 to Nov 1, 2014 Causal relationship between AF & stroke Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation - Venice,
More informationDirect oral anticoagulants for Embolic Strokes of Undetermined Source? George Ntaios University of Thessaly, Larissa/Greece
Direct oral anticoagulants for Embolic Strokes of Undetermined Source? George Ntaios University of Thessaly, Larissa/Greece Disclosures Scholarships: European Stroke Organization; Hellenic Society of Atherosclerosis.
More informationSubclinical AF: Implications of device based episodes
Subclinical AF: Implications of device based episodes Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC Disclosures: Clinical Trials and Consulting: Medtronic, Boston Scientific
More information2017 Cardiovascular Symposium CRYPTOGENIC STROKE: A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A.
CRYPTOGENIC STROKE: 2017 Cardiovascular Symposium A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A. CRYPTOGENIC STROKE CRYPTOGENIC: OF OBSCURE OR UNKNOWN
More informationSixth Annual Intensive Update in Neurology 9/15-16/2016. W Tom Kushner DO Swedish Stroke Clinic Neurohospitalist
W Tom Kushner DO Swedish Stroke Clinic Neurohospitalist 1 One Strategy for cryptogenic stroke: ESUS Positively defined criteria FDA allows clinical trials NOACs have lower risk profile Another strategy
More informationMohammad Zubaid, MB, ChB, FRCPC, FACC
Management and one year outcome of atrial fibrillation in Middle Eastern cohort enrolled in the observational Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) Mohammad Zubaid, MB, ChB, FRCPC, FACC
More informationCryptogenic Stroke: A logical approach to a common clinical problem
Cryptogenic Stroke: A logical approach to a common clinical problem Alphonse M. Ambrosia, DO, FACC Interventional Cardiologist CardioVascular Associates of Mesa Mesa, Arizona Speakers Bureau Boston Scientific
More informationManagement of Atrial Fibrillation. Leon Ptaszek, MD, PhD, FACC, FHRS 25 March 2018
Management of Atrial Fibrillation Leon Ptaszek, MD, PhD, FACC, FHRS 25 March 2018 Disclosures Speaker: St. Jude Medical, Biotronik Consultant: St. Jude Medical, World Care Clinical Objectives Recognize
More informationNT-proBNP For The Detection of Silent Paroxysmal Atrial Fibrillation In Patients With Recent Cerebral Ischemia results from the Find-AF trial
NT-proBNP For The Detection of Silent Paroxysmal Atrial Fibrillation In Patients With Recent Cerebral Ischemia results from the Find-AF trial R. Wachter a, R. C. Lahno a, B. Haase a, M. Weber-Krüger a,
More informationΑΣΥΜΠΤΩΜΑΤΙΚΗ ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ
ΑΣΥΜΠΤΩΜΑΤΙΚΗ ΚΟΛΠΙΚΗ ΜΑΡΜΑΡΥΓΗ ΓΕΩΡΓΙΟΣ ΣΤΑΥΡΟΠΟΥΛΟΣ Β ΚΑΡΔΙΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ ΠΓΝΘ ΙΠΠΟΚΡΑΤΕΙΟ 9 Ο Βορειοελλα ATRIAL FIBRILATION Atrial fibrillation (AF) is the most common clinically significant heart
More informationThrombolysis-WAKE UP Intra-arterial interventions DEFUSE 3 Haemorrhagic Stroke - TICH 2 Secondary Prevention CROMIS 2 Secondary Prevention NAVIGATE
Thrombolysis-WAKE UP Intra-arterial interventions DEFUSE 3 Haemorrhagic Stroke - TICH 2 Secondary Prevention CROMIS 2 Secondary Prevention NAVIGATE ESUS Progression of haematoma Anticoagulation Large ICH
More informationAsymptomatic Atrial Fibrillation: Detection and Management. 18 December nd Annual Advances in Heart Disease Palace Hotel, San Francisco
Asymptomatic Atrial Fibrillation: Detection and Management 18 December 2015 32 nd Annual Advances in Heart Disease Palace Hotel, San Francisco Zian H. Tseng, M.D., M.A.S. Associate Professor of Medicine
More informationThe Relationship Between Daily Atrial Tachyarrhythmia Burden From Implantable Device Diagnostics and Stroke Risk: The TRENDS Study
The Relationship Between Daily Atrial Tachyarrhythmia Burden From Implantable Device Diagnostics and Stroke Risk: The TRENDS Study Taya V. Glotzer, MD; Emile G. Daoud, MD; D. George Wyse, MD, PhD; Daniel
More informationConsensus document: Screening and Prevention of Atrial Fibrillation
Consensus document: Screening and Prevention of Atrial Fibrillation Yong-Seog Oh, M.D.,Ph.D. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary s Hospital, College of Medicine, The
More informationRisk Stratification for Stroke Prevention in Patients with Atrial Fibrillation: The emerging role of biomarkers
Risk Stratification for Stroke Prevention in Patients with Atrial Fibrillation: The emerging role of biomarkers Banff 2013 CP1221547-8 Meta-Analysis of Stroke 5 Randomized Trials Placebo Stroke Rate 4.5%/yr
More informationקוים מנחים לפרפור פרוזדורים - עדכון משה סויסה מרכז רפואי קפלן
קוים מנחים לפרפור פרוזדורים - עדכון משה סויסה מרכז רפואי קפלן INTRODUCTION The prevalence of atrial fibrillation (AF) is approximately 1.5 2% of the general population The arrhythmia is associated: with
More informationHow Can We Properly Manage Patients With Stroke of Undetermined Origin?
How Can We Properly Manage Patients With Stroke of Undetermined Origin? : Spotlight on Embolic Stroke of Undetermined Source (ESUS) MI SUN OH Department of Neurology, Hallym University Scared Heart Hospital,
More informationFibrillazione Atriale Fattore di Rischio o Marker di Stroke: Implicazioni Per La Terapia
Gianluca Botto, FESC Elettrofisiologia Ospedale Sant Anna, Como Fibrillazione Atriale Fattore di Rischio o Marker di Stroke: Implicazioni Per La Terapia 20 min Presenter Disclosure Information n n n Research
More informationMedicare Advantage Medical Policy
Medicare Advantage Medical Policy Current Policy Effective Date: 1/1/18 Title: Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry Description/Background Indications for Ambulatory Cardiac
More informationCRYPTOGENIC STROKE THERAPY AWARENESS PRESENTATION. Reveal LINQ TM
CRYPTOGENIC STROKE Reveal LINQ TM Insertable Insertable Cardiac Cardiac Monitoring Monitoring System System THERAPY AWARENESS PRESENTATION Epidemiology Diagnosis Guidelines and Evidence to Support Reveal
More informationNational Medical Policy
National Medical Policy Subject: Implantable Cardiac Event Monitors Policy Number: NMP495 Effective Date*: November 2009 Update: May 2016 ARCHIVE: NOTE: This policy has been retired. Please use DME Policy
More informationCryptogenic Stroke: Finding Light in the Darkness
Cryptogenic Stroke: Finding Light in the Darkness Scott E. Kasner, MD Professor of Neurology Director, Comprehensive Stroke Center Disclosures WL Gore PI for Gore REDUCE Trial Medtronic DSMB for CRYSTAL
More informationSeek and Ye Shall Find: Surprising Findings When Using the ILR-LINQ
Seek and Ye Shall Find: Surprising Findings When Using the ILR-LINQ Suneet Mittal, MD, FACC, FHRS Director, Electrophysiology Laboratory Valley Health System www.arrhythmia.org; @drsuneet October 31, 2015
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute ischemic stroke TOAST classification of, 270 Acute myocardial infarction (AMI) cardioembolic stroke following, 207 208 noncardioembolic
More informationAtrial fibrillation (AF) has been the. Subclinical Atrial Fibrillation, Embolic Risk, and Anticoagulant Treatment
MAEDICA a Journal of Clinical Medicine 2018; 13(4): 261-265 https://doi.org/10.26574/maedica.2018.13.4.261 Mædica - a Journal of Clinical Medicine Invited Editorial Point of View Subclinical Atrial Fibrillation,
More informationWhy to monitor AF ablation success?
Why to monitor AF ablation success? Why to monitor AF ablation success? CASTLE-AF Primary Endpoint All-cause mortality Worsening heart failure admissions Secondary Endpoints All-cause mortality Worsening
More informationOcclusion de l'auricule gauche: Niche ou réel avenir? D Gras, MD, Nantes, France
Occlusion de l'auricule gauche: Niche ou réel avenir? D Gras, MD, Nantes, France LAA Occlusion Is there a real future? Background Protect AF Trial Other Studies CAP, ASAP, Prevail Left Atrial Appendage
More informationIdentifying Patients for Anticoagulation: While Many Patients Remain Untreated, Who Should NOT be Anticoagulated?
Identifying Patients for Anticoagulation: While Many Patients Remain Untreated, Who Should NOT be Anticoagulated? Renato D. Lopes, MD MHS PhD Professor of Medicine Division of Cardiology Duke Clinical
More informationLa strategia diagnostica: il monitoraggio ecg prolungato. Michele Brignole
La strategia diagnostica: il monitoraggio ecg prolungato Michele Brignole ECG monitoring and syncope In-hospital monitoring Holter Monitoring External loop recorder Remote (at home) telemetry Implantable
More informationCan Catheter Ablation of AF Reduce the Risk of Stroke? CCCEP 2015 October 31, 2015
Can Catheter Ablation of AF Reduce the Risk of Stroke? CCCEP 2015 October 31, 2015 Atul Verma, MD FRCPC FHRS Director, Heart Rhythm Program Southlake Regional Health Centre Newmarket, Ontario, Canada Chair,
More informationRebuttal. Jerónimo Farré MD 2010
Rebuttal 1.We do not know what are the types of AF in which ablation is worthless or most effective 2.Waiting implies to consider the ablation at an older age and when the duration of the history of AF
More informationIs Stroke Frequency Declining?
Is Stroke Frequency Declining? Etiologic Factors Clinical, Anatomic, Technique-related, and Device-specific Samir Kapadia, MD Professor of Medicine Section head, Interventional Cardiology Director, Cardiac
More informationPFO Management update
PFO Management update May 12, 2017 Peter Casterella, MD Swedish Heart and Vascular 1 PFO Update 2017: Objectives Review recently released late outcomes of RESPECT trial and subsequent FDA approval of PFO
More informationSpontaneous Atrial Fibrillation and Noacs and Reversal agents
Spontaneous Atrial Fibrillation and Noacs and Reversal agents Laurent Lewkowiez, MD Regional Service Chief, Hospital Cardiology CPMG Cardiac Electrophysiology Educational Goals relationship between atrial
More informationFORAME OVALE PERVIO E ICTUS CRIPTOGENETICO: Dimensione del problema. Roberto Mantovan, MD, PhD U.O. Cardiologia Ospedale M.
FORAME OVALE PERVIO E ICTUS CRIPTOGENETICO: Dimensione del problema Roberto Mantovan, MD, PhD U.O. Cardiologia Ospedale M. Bufalini - Cesena FORAME OVALE PERVIO ICTUS CRIPTOGENETICO FORAME OVALE PERVIO
More informationFibrillazione atriale: è sempre necessario ricercarla, e come?
Fibrillazione atriale: è sempre necessario ricercarla, e come? Domenico Prisco DMSC Università di Firenze SOD Medicina Interna Interdisciplinare AOU Careggi Firenze 23-10-2018 Disclosure Fees for lectures
More informationAF monitoring and stroke: XPECT & REVEAL LINQ. Helmut Pürerfellner, Linz, Austria
AF monitoring and stroke: XPECT & REVEAL LINQ Helmut Pürerfellner, Linz, Austria 2 Medtronic Confidential 3 Circ Arrhythm Electrophysiol 2010;3:141-47 Reveal XT versus LINQ 5 Parameter Reveal XT Reveal
More informationTransient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction
Transient Atrial Fibrillation and Risk of Stroke after Acute Myocardial Infarction Doron Aronson MD, Gregory Telman MD, Fadel BahouthMD, Jonathan Lessick MD, DSc and Rema Bishara MD Department of Cardiology
More informationWatchman and Structural update..the next frontier. Ari Chanda, MD Cardiology Associates of Fredericksburg
Watchman and Structural update..the next frontier Ari Chanda, MD Cardiology Associates of Fredericksburg Different Left Atrial Appendage (LAA) morphologies Watchman (the device) Fabric Anchors Device structure
More informationManagement of Patients with Atrial Fibrillation Undergoing Coronary Artery Stenting 경북대의전원내과조용근
Management of Patients with Atrial Fibrillation Undergoing Coronary Artery Stenting 경북대의전원내과조용근 Case (2011, 5) 74-years old gentleman Exertional chest pain Warfarin with good INR control Ex-smoker, social(?)
More informationPermanent foramen ovale: when to close?
Permanent foramen ovale: when to close? Pierre Amarenco INSERM U-698 and Denis Diderot University - Paris VII Department of Neurology and Stroke Center Bichat hospital, Paris, France PFO - Pathology TEE
More informationCardiac Electrophysiology
Cardiac Electrophysiology Tamara Langeberg, CNP Minneapolis Heart Institute Cardiac Electrophysiology February 27, 2018 Disclosures None 2 Objectives Rhythm identification Identify indications for cardiac
More informationPrimary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion. Greg Francisco, MD, FACC
Primary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion Greg Francisco, MD, FACC DISCLOSURES None to declare Estimated 33.5million have AF worldwide (6-7million in
More informationREVEAL AF IN YOUR CRYPTOGENIC STROKE PATIENTS
REVEAL AF IN YOUR CRYPTOGENIC STROKE PATIENTS Reveal LINQ TM Insertable Cardiac Monitoring System Are You Looking Long Enough? ONE-THIRD OF ISCHEMIC STROKES ARE CRYPTOGENIC (UNEXPLAINED) 1-6 HOW DO YOU
More informationStroke Case Studies. Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow
Stroke Case Studies Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow Case 1 64 year old female with dysphasia and right arm weakness 3 hours prior CT head: dense M1 sign. No established ischaemia
More informationCritical Review Form Therapy
Critical Review Form Therapy A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects, Lancet-Neurology 2007; 6: 953-960 Objectives: To evaluate the effect of
More informationRuolo della ablazione della fibrillazione atriale nello scompenso cardiaco
Ruolo della ablazione della fibrillazione atriale nello scompenso cardiaco Matteo Anselmino Division of Cardiology Città della Salute e della Scienza Hospital University of Turin, Italy Disclosure: Honoraria
More informationStroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University
Stroke Prevention in AF: How will it change in the next 5 years? Jeff Healey MD, MSc, FHRS Population Health Research Institute McMaster University Disclosures Research Grants and speaking fees St. Jude
More informationCRYPTOGENIC STROKE. Reveal LINQ TM THERAPY AWARENESS PRESENTATION
CRYPTOGENIC STROKE Reveal LINQ TM Insertable Insertable Cardiac Cardiac Monitoring Monitoring System System THERAPY AWARENESS PRESENTATION AGENDA Epidemiology Diagnosis & Monitoring Strategies Evidence
More information» A new drug s trial
» A new drug s trial A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause
More informationDiagnostic and therapeutic management of the patient with syncope M. Brignole Arrhythmologic Centre and Syncope Unit Lavagna, Italy
Diagnostic and therapeutic management of the patient with syncope M. Brignole Arrhythmologic Centre and Syncope Unit Lavagna, Italy Eur Heart J. 2009 Nov;30(21):2631-71 Available on www.escardio.org/guidelines
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry Page 1 of 33 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Ambulatory Event Monitors and Mobile
More informationCoagulation and ischaemic stroke
ESC Council on Stroke ESC Heart & Brain Workshop Prague, January 2018 Coagulation and ischaemic stroke Wolfram Doehner, PD, PhD Center for Stroke Research Berlin & Department of Cardiology, Campus Virchow
More informationΜηνύματα από τις σπουδαιότερες μελέτες στην ηλεκτροφυσιολογία το διάστημα
Μηνύματα από τις σπουδαιότερες μελέτες στην ηλεκτροφυσιολογία το διάστημα 2015-2016 Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος Dr. Konstantinou has received
More informationAtrial fibrillation and advanced age
Atrial fibrillation and advanced age Prof. Fiorenzo Gaita Director of the Cardiology School University of Turin, Italy Prevalence of AF in the general population Prevalence and age distribution in patients
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: ambulatory_event_monitors 10/2000 4/2017 4/2018 5/2017 Description of Procedure or Service There are a wide
More informationManagement of atrial fibrillation a holistic view - Prof. Dr. Martin Borggrefe Mannheim
a holistic view - Prof. Dr. Martin Borggrefe Mannheim Patients with atrial fibrillation (millions) 16 14 12 10 8 6 4 2 0 Management of atrial fibrillation Expected prevalence of apparent AF 5,1 5,1 5,9
More informationClinical Study Predictors of Occult Paroxysmal Atrial Fibrillation in Cryptogenic Strokes Detected by Long-Term Noninvasive Cardiac Monitoring
SAGE-Hindawi Access to Research Stroke Research and Treatment Volume 2011, Article ID 172074, 5 pages doi:10.4061/2011/172074 Clinical Study Predictors of Occult Paroxysmal Atrial Fibrillation in Strokes
More informationAblation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation
Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation 25 October 2008 Update in Electrocardiography and Arrhythmias Zian H. Tseng, M.D., M.A.S. Assistant Professor
More informationCryptogenic Stroke/PFO with Thrombophilia and VTE: Do We Know What To Do?
Cryptogenic Stroke/PFO with Thrombophilia and VTE: Do We Know What To Do? Robert J. Sommer, MD Columbia University Medical Center New York, NY Disclosure Statement of Financial Interest Within the past
More informationControversies in Risk Stratification
Controversies in Risk Stratification Things are not as simple as they seem Banff 2017 2015 MFMER 3494750-5 Relative importance Triggers vs Substrate in Pathophysiology of AF AF burden Paroxysmal? Persistent?
More informationEmbolinen aivoinfarkti vailla
Embolinen aivoinfarkti vailla syytä (ESUS) Neurologipäivät 2.11.2017 Jukka Putaala, vsel HYKS 1 Disclosures Research grant Helsinki and Uusimaa Hospital District, Academy of Finland, Finnish Funding Agency
More informationPost-ablation Management: Drug therapy, Anticoagulation and long-term Monitoring
Catheter Ablation of Atrial Fibrillation: State of the Art Post-ablation Management: Drug therapy, Anticoagulation and long-term Monitoring Dipen Shah Service de Cardiologie Hospital Cantonal de Genève
More informationFibrillazione atriale : causa diretta marker di rischio di eventi cerebrovascolari non solo embolici?
Fibrillazione atriale : causa diretta marker di rischio di eventi cerebrovascolari non solo embolici? Fabrizio Ammirati Dipartimento Medicina UOC Cardiologia Ospedale GB Grassi ASL Roma 3 Sept 2013 Patients
More informationDEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE. Matthew Starr, MD Stroke Attending
DEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE Matthew Starr, MD Stroke Attending DISCLOSURES None DEBATE Should PFO be closed? * * Sometimes yes THE CASE AGAINST PFO CLOSURE 1. Did the PFO cause the
More informationShould AF patients (after ablation) have anticoagulation forever? Can we ever stop it?
The 12 International Dead Sea Symposium - Jerusalem March 3-5 /2014 Should AF patients (after ablation) have anticoagulation forever? Can we ever stop it? Antonio Raviele, MD, FESC, FHRS Past Director
More informationCLINICAL FEATURES THAT SUPPORT ATHEROSCLEROTIC STROKE 1. cerebral cortical impairment (aphasia, neglect, restricted motor involvement, etc.) or brain stem or cerebellar dysfunction 2. lacunar clinical
More informationPOWERFUL CARDIAC MONITORING
POWERFUL CARDIAC MONITORING Indications, Guidelines, Clinical Evidence, and Coding Overview for Diagnosing Suspected Arrhythmias and Monitoring Known A-Fib Reveal LINQ Insertable Cardiac Monitoring System
More informationSecondary Stroke Prevention: A Precautionary Tale
Secondary Stroke Prevention: A Precautionary Tale Kirsten George-Phillips, BSP Clinical Practice Leader, AHS Clinical Pharmacist, AHS Owen Stroke Prevention Clinic Learning Objectives! Examine literature
More informationAmbulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry Policy Number: Original Effective Date: MM.02.021 02/01/2014 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 07/28/2017
More informationEAE RECOMMENDATIONS FOR TRANSESOPHAGEAL ECHO. Cardiac Sources of Embolism. Luigi P. Badano, MD, FESC
EAE RECOMMENDATIONS FOR TRANSESOPHAGEAL ECHO. Cardiac Sources of Embolism Luigi P. Badano, MD, FESC Background Stroke is the 3 cause of death in several industrial countries; Embolism accounts for 15-30%
More informationCardiovascular complica/ons a1er stroke
EANS ESC Council on Stroke joint session Venice, October 2017 Cardiovascular complica/ons a1er stroke Wolfram Doehner, PD, PhD Center for Stroke Research Berlin & Department of Cardiology, Campus Virchow
More informationAlan Barber. Professor of Clinical Neurology University of Auckland
Alan Barber Professor of Clinical Neurology University of Auckland Presented with Non-fluent dysphasia R facial weakness Background Ischaemic heart disease Hypertension Hyperlipidemia L MCA branch
More informationIctus criptogenetico: possiamo ridurre questa diagnosi?
FIBRILLAZIONE ATRIALE Ictus criptogenetico: possiamo ridurre questa diagnosi? Maurizio Landolina MD, FESC Direttore U.O.C. Cardiologia, Ospedale Maggiore di Crema Disclosures Speakers bureau appointment
More informationAmbulatory Cardiac Monitors and Outpatient Telemetry Corporate Medical Policy
Ambulatory Cardiac Monitors and Outpatient Telemetry Corporate Medical Policy File Name: Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry File Code: UM.SPSVC.13 Origination: 10/2015 Last
More informationPrimary Prevention of Stroke
Primary Prevention of Stroke Dr Chris Ellis Cardiologist Green Lane CVS Service, Auckland City Hospital & Auckland Heart Group, Mercy Hospital, Auckland 67 Pages Long, 735 References 29 Sub-Headings for
More informationAmbulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry Policy Number: 2.02.08 Last Review: 9/2018 Origination: 11/2002 Next Review: 9/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue
More informationFibrillazione atriale e scompenso: come interrompere il circolo vizioso.
Alessandria, September 23 th 2017 Fibrillazione atriale e scompenso: come interrompere il circolo vizioso. Professor Fiorenzo Gaita Chief of the Cardiovascular Department Città della Salute e della Scienza
More informationPapel da imagem na estratificac ão de risco e na predic ão do risco tromboemboĺico
Imagiologia na Fibrilhac ão Auricular Papel da imagem na estratificac ão de risco e na predic ão do risco tromboemboĺico Mª João Andrade Diagnosis and timely detection of atrial fibrillation Echo-machines
More informationECTOPIC BEATS: HOW MANY COUNT?
ECTOPIC BEATS: HOW MANY COUNT? Rupert FG Simpson, 1 Jessica Langtree, 2 *Andrew RJ Mitchell 2 1. King s College Hospital, London, UK 2. Jersey General Hospital, Jersey, UK *Correspondence to mail@jerseycardiologist.com
More informationFibrillazione atriale subclinica e rischio di ictus ischemico
Fibrillazione atriale subclinica e rischio di ictus ischemico Background 25% of all ischemic strokes are cryptogenic, and subclinical atrial fibrilla;on (AF) is suspected to be a possible cause in many
More informationUpdates in Stroke Management. Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy
Updates in Stroke Management Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy Disclosure I have no actual or potential conflict of interest
More informationPOLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY
Original Issue Date (Created): 7/1/2002 Most Recent Review Date (Revised): 2/28/2018 Effective Date: 10/1/2018 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS
More informationOAC after apparently successfull AF ablation: when, why, and how?
Gulf EP Live 2015 - Dubai January 22-24 / 2015 OAC after apparently successfull AF ablation: when, why, and how? Antonio Raviele, MD, FESC, FHRS Past Director Cardiovascular Department, dell Angelo Hospital,
More information